Registered Nurse

Humana in Anchorage, AK

  • Industry: Healthcare - Nursing - Registered Nurse (RN/BSN/ASN)
  • Type: Full Time
  • Compensation: $87,510.00 - 119,210.00 / Year*
position filled
DescriptionThe Senior Nurse Auditor performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The Senior Nurse Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.ResponsibilitiesThe Senior Nurse Auditor validates and interprets medical documentation to ensure capture of all relevant coding. Identifies members with high risk CMS Hierarchical Condition Categories (HCC) and refers cases for annual follow-up care by disease management, case management, and primary care providers as appropriate for assessment/intervention. Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. Applies clinical and coding experience to conduct reviews of provider codes and billing. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.Required Qualifications + Licensed Registered Nurse, RN, in the state of residence without any restrictions + Minimum 5 years diverse clinical acute care experience, in hospital, Cardiac, Med Surg, Ortho, OBGYN+ Proficiency with MS Office Suite+ Ability to work independently under general instructions and with a team+ Must be passionate about contributing to an organization focused on continuously improving consumer experiencesAdditional RequirementsHours: Must be willing to work a 40-hour work shift Monday-FridayWork Style: Remote/Work at Home + Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work+ Must have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)+ Travel: About 2-4 times a year for business meetingsPreferred Qualifications+ BSN or Bachelor's degree in a related field+ Health Plan experience working with large carriers+ Previous Medicare/Medicaid experience a plus+ Coding Certifications AAPC or AHIMA+ Previous experience in auditing medical claims+ Experience working with MCG or Interqual guidelinesScheduled Weekly Hours40About UsMission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms -when and where they need it. Our employees are at the heart of making this happen and that's why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity EmployerIt is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact for assistance.Humana Safety and SecurityHumana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact to validate the request.
Associated topics: asn, care unit, ccu, coronary, domiciliary, hospice, intensive, intensive care, registered nurse, surgery

* Estimated salary


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